Chronic Care Management (CCM)
CCM codes (99490, 99491, etc.) reimburse for the non-face-to-face time spent managing patients with two or more chronic conditions. This includes care planning, medication reconciliation, and coordinating with other providers. The key to successful CCM billing is meticulous time tracking by clinical staff and obtaining written patient consent before initiating the service. These are monthly codes, so you can bill them for each month you meet the time and documentation requirements.
Transitional Care Management (TCM)
TCM services (CPT codes 99495 and 99496) are for managing a patient's transition from an inpatient setting (like a hospital or skilled nursing facility) back to their home. Billing for TCM has strict requirements: you must make contact with the patient within two business days of discharge and have a face-to-face visit within 7 or 14 days, depending on the complexity. The codes offer high reimbursement rates, but you must adhere to the timeline perfectly.
Don't Miss the Window: Failure to meet the 2-day contact or 7/14-day visit window will make the entire service non-billable. Having a solid workflow to track hospital discharges is essential.
